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Pursuant to a legislative requirement, GAO reviewed the: (1) changes in overall access to care, changes in access to certain specialized services, and a comparison of changes in Veterans Integrated Service Network (VISN) 3 (Bronx) and VISN 4 (Pittsburgh) with Department of Veterans Affairs (VA) national data from fiscal years (FY) 1995 to 1997; (2) extent to which VA headquarters and VISNs are working to equitably allocate resources to facilities within VISNs; and (3) adequacy of VA's oversight of changes in access to care.

GAO noted that: (1) overall, VISN 3, VISN 4, and VA nationally have increased access as measured by increases in the number of veterans served; (2) access to care, as measured by patient satisfaction, also seems to have improved according to responses to VA surveys and interviews GAO conducted; (3) in addition, VA has improved geographic access to primary care by increasing the number of community-based clinics in these two VISNs; (4) although access has increased overall, access appears to have decreased for some specific services; (5) the two VISNs GAO reviewed used no specific criteria for allocating their resources to reduce historical access inequities among their facilities; (6) VA headquarters neither provides criteria for VISNs to use to equitably allocate resources nor reviews the allocations for equity; (7) although VA has made progress in improving the equity of resource allocations nationwide among the networks, it has done little to ensure that the networks fulfill the Veterans Equitable Resource Allocation (VERA) system's promise as they allocate resources to their facilities; (8) although GAO prepared an overall assessment of access to care, difficulties in working with the data cast doubt on whether VA can perform timely and effective oversight; (9) the information GAO developed on changes in access to care at the facility and network levels for VISN 3 and VISN 4, as well as for VA nationally, was gathered from many VA reports and databases--some of which had inconsistent or incompatible information that GAO was able to resolve; (10) moreover, medical center, VISN, and headquarters officials told GAO that such data are not available on a routine, timely basis; (11) without such information, it is difficult for them to say conclusively whether VA has improved veterans' equity of access to care and whether veterans have not been adversely affected by the many changes under way to reduce costs and improve productivity; (12) by taking several actions, VA could improve its oversight of changes in access to care and its resource allocation process; and (13) these actions include improving data collection and dissemination efforts regarding changes in access to care and establishing criteria for VISNs to use for more equitably allocating resources to their facilities.

Recommendations for Executive Action

Status: Closed - Implemented

Comments: VA has implemented indicators of clinic waiting times to measure timeliness and access at to care at both the network and facility level. VA implemented waiting times for next available appointments in February, 2000. In February 2001 VA added additional waiting time indicators to provide management with other ways of measuring timeliness and access. These include average waiting time for all appointments, average waiting time for new patients, and average waiting time for established patients. In addition, VA has implemented other measures such as proportion of discharges to non-institutional settings from spinal cord injury and domiciliary care. Also VA has implemented measures of spinal cord injury care patients' rating of their inpatient and outpatient care.

Recommendation: The Secretary of Veterans Affairs should direct the Undersecretary of Health to develop uniform definitions and institute timely reporting of changes in access to care, including the number and eligibility priority of patients served, waiting times for care, and patient satisfaction for specific services at the VISN and facility level.

Agency Affected: Department of Veterans Affairs

Status: Closed - Implemented

Comments: As previously reported, VA revised its Directive 97-054 to its health care networks regarding their allocation of resources to facilities. The revision states that each network allocation model will support the goal of improving equitable access to care and ensure appropriate allocation of resources to meet that goal. This revision was incorporated into the directive in final on November 19, 1998. VA has been measuring clinic waiting times since Feb, 2000 and added more waiting time indicators in Feb 2001 that provide information at the network and facility level. This provides VA information for using in accessing the impact of resource allocation on equitable access within and between networks.

Recommendation: The Secretary of Veterans Affairs should direct the Undersecretary of Health to develop criteria for equitably allocating resources to facilities and monitor any improvements in equity of access among and within VISNs.